Childhood Moyamoya Presenting as Subarachnoid Hemorrhage

To the Editor.—  Moyamoya was originally thought to represent the roentgenographic expression of a congenital cerebrovascular anomaly indigenous to the Japanese.¹ Subsequently, this syndrome has been reported as an acquired process in non-Japanese adults and children.^2-6 A recent review⁴ of moyamoya in children has documented more than 100 non-Japanese cases. I have cared for two children in whom the presentation of moyamoya again demonstrates its acquired nature and in whom the mode of presentation has rarely been noted in children.

Report of Cases.—  Case 1.—A 41/2-year-old Italian boy underwent total correction of transposition of the great vessels. A right hemiparesis occurred after postoperative anoxia. He recovered with minimal residua. At age 11 years, he had a subarachnoid hemorrhage (SAH). Computerized tomography of the brain showed a left frontal lobe hematoma subadjacent to frontoparietal atrophy. Cerebral angiography demonstrated moyamoya of the left middle cerebral artery. He has